Friday Memo- September 6, 2019

Dear Team-

            In managing any enterprise, there always is a balance between the lure of innovation and the necessity of keeping the proverbial trains running on time. The best organizations do both, with excellence. That is the way to grow and thrive.

            Innovation and improving operations should never be competing values. Ideally, they are complementary. Here is a current, real time, Community Healthcare Network example.

            Access to health care is a major factor in health disparities for people of color, people with disabilities (physical and behavioral), poor people, and older folks. Technology, especially tele-health, is a tool to reduce obstacles to access. CHN, constantly looking to improve access – think of our fleet of mobile health centers and the East New York Health Hub –is digging deeply into the future of tele-health.

           CHN has invested in a pilot program to provide psychiatric visits to patients via video conferencing. It has been an eye-opening success.

           The logistics worked out. We set up a room at the Harlem Health Center where psychiatric providers meet with their patients who, with supporting staff help, sit in a private office at our Tremont Health Center. Over the past nine months, CHN conducted over 300 visits via tele-psych, and the patient experience was overwhelmingly positive.

           During the summer, CHN conducted interviews with several of the patients, and collected survey results from many more patients. Nearly all of the patients feel at least as satisfied with the tele-visit as they do with in-person visits. In fact, a fascinating finding was that patients felt less stress in having the distance between themselves and the provider, and several said they preferred the remote access.

           It was a coincidence, I think, that the leading psychiatric providers seeing patients remotely are both named Anna –  Psychiatrist Anna Shapiro and Psychiatric Nurse Practitioner Anna Foster. While the technology worked (thank you, IT), there is no doubt that the excellent care provided by our “Annas” is the linchpin of success.

           We will continue to explore new ways of exploiting tele-medicine to serve better our patients. Over time, as regulatory reform inches its way forward at government agencies, we can envision home visits and many other access breakthroughs, all aided by technological advances. This fall, by way of example, we will provide tele-psychiatric care to residents in shelters operated by Care for the Homeless, an allied non-profit organization. We plan more partnerships.

           We recognize that we must balance innovation with operational focus. CHN is laser-like focused on our current pain points–pain points for both staff and patients. In a sentence, we must solve provider and nursing shortages, scheduling snafus, quick access to appointments, health center workflows, and the accompanying prolonged patient wait time. These challenges plague CHN, as they challenge nearly all health care providers.

           Innovation is not a distraction from these challenges. Innovations, such as tele-medicine, will be part of the solution to these challenges. We will innovate and keep our eye on the day to day.


               I will end with good news. During past months, we have kept you advised of the battle with the Trump Administration over Title X funding, the federal monies that help support family planning counselling at CHN, and across the county.

              The Trump Administration issued a Rule that tied acceptance of Title X funding to compliance with a “gag rule,” a prohibition on counselling patients on their full range of health care options when pregnant. CHN, as you know, refused to accept Title X funds under this Rule, declaring that it imposed a requirement of unethical medical practice.

              Late in August, New York State agreed to support us and other organizations in the state by providing funding that will cover the gap left from refusing Title X funds, a commitment to decency and ethical care for family planning providers.

            Good for New York, awful still for most of the nation. Litigation to strike down the federal “gag rule” nationally continues in California. CHN, and New York State, support that lawsuit.

          Have a good weekend.